Men, Bone Fracture, and Prostate Cancer

Researchers from the Cancer Institute of New Jersey have done a landmark study. This work, which involved the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, details the impact on men with a high risk of bone fracture who are receiving long-term androgen deprivation therapy (ADT) for prostate cancer. Yes, their research indicates that this population has a higher fracture incidence following treatment completion. The findings also show that men who experienced a fracture had a 1.38-fold higher mortality risk than those who did not.

The researchers reviewed information on demographics and tumor characteristics from 75, 994 men aged 66 and older who were diagnosed as having localized prostate cancer from 1992 to 2007. All of the SEER registries hold the highest level of certification of data quality. A risk assessment scale for baseline skeletal complications—including fracture—was created, utilizing the presence of certain conditions within one year prior to cancer diagnosis. These conditions included diabetes, alcohol and cigarette use, paralysis, and liver disease.

Investigators found that during a 12-year follow up, more than 58%of men deemed at high fracture risk prior to treatment and 38% considered at low risk developed at least one fracture following ADT. The research also showed that men with a high baseline risk had a higher probability of receiving ADT (52.1%) compared to those with a low baseline risk (38.2%). It was also determined that those men receiving ADT by itself were likely to have a stronger dose than those who received ADT in combination with other treatments for their prostate cancer. Mortality risk was found to be 40% higher within two years after experiencing a fracture.

“Our findings suggest that treating men having a high baseline risk of fracture with long-term androgen deprivation therapy may have serious adverse consequences, ” said senior author Grace Lu-Yao, Ph.D., M.P.H., in the January 17, 2013 news release. Dr. Lu-Yao is a cancer epidemiologist at The Cancer Institute of New Jersey and professor of medicine at Robert Wood Johnson Medical School and of epidemiology at UMDNJ-School of Public Health. “We anticipate the results of this study will prompt further examination of a patient’s baseline-risk of fracture and skeletal complications prior to administering this course of therapy.”

Asked about future research, Dr. Lu-Yao told OTW, We need to examine and compare alternative treatment options for patients with high-baseline fracture risk.

As for what orthopedic surgeons can do, she commented to OTW, “By further educating patients on the potential outcomes following ADT treatment, the patient can make a better and more informed decision.”